Cultivating Evidence-Based Clinical Reasoning and Action in Youth Mental Health Care: The Reaching Families Multisite Randomized Trial

Objective: Despite decades of policy emphasizing the role of evidence in guiding services, few studies have sought to improve the degree to which evidence is used in supervision and treatment. This study reports supervisor and therapist outcomes from the Reaching Families multisite cluster-randomized controlled trial, which tested the effects of a coordinated knowledge system (CKS) against practice guidelines (PG) on the use of evidence in supervision and treatment targeting low treatment engagement in publicly funded youth community mental health organizations located in two geographically distinct, underresourced communities where service inequities are common. Method: The sample included 121 mental health professionals (92.6% female; 81.0% Black, Indigenous, and people of color(1)) randomly assigned to a CKS or PG control condition. We recorded, transcribed, and coded 430 supervision and 208 treatment sessions involving 221 youth (M-age = 13.1 years, 46.2% female; 78.7% Black, Indigenous, and people of color) and/or their caregivers who reported engagement concerns during therapy. Results: CKS dyads showed uniformly greater use of evidence focused on specific client needs relative to dyads in the PG condition, with large effect sizes and no differences in the effect of condition across the sites. Secondary analyses showed that tools in the CKS condition were perceived significantly more positively than those in the PG condition in terms of effort and effectiveness, and supervisory workload was the same across both conditions. Conclusions: In routine clinical care delivered within highly representative community settings, a strategically designed knowledge resource can improve evidence-based reasoning and action and be perceived as easy to use and useful without negatively impacting workload.